<!--
  ========================LICENSE_START=================================
  screenit-web
  %%
  Copyright (C) 2012 - 2020 Facilitaire Samenwerking Bevolkingsonderzoek
  %%
  This program is free software: you can redistribute it and/or modify
  it under the terms of the GNU Affero General Public License as published by
  the Free Software Foundation, either version 3 of the License, or
  (at your option) any later version.
  
  This program is distributed in the hope that it will be useful,
  but WITHOUT ANY WARRANTY; without even the implied warranty of
  MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  GNU General Public License for more details.
  
  You should have received a copy of the GNU Affero General Public License
  along with this program.  If not, see <http://www.gnu.org/licenses/>.
  =========================LICENSE_END==================================
  -->
<html xmlns:wicket>
<wicket:panel>
    <fieldset>
        <form wicket:id="form" class="form-horizontal">
            <div class="row-fluid">
                <div class="span6">
                    <div class="control-group">
                        <label class="control-label">
                            <wicket:message key="barcode"/>
                        </label>

                        <div class="controls">
                            <input class="input" type="text" wicket:id="monsterId">
                        </div>
                    </div>
                    <div class="control-group">
                        <label class="control-label">BSN</label>

                        <div class="controls">
                            <input class="input" type="text" wicket:id="bsn">
                        </div>
                    </div>
                    <wicket:enclosure child="geboortedatum">
                        <div class="control-group">
                            <label class="control-label">Geboortedatum</label>

                            <div class="controls">
                                <input class="input" type="text" wicket:id="geboortedatum">
                            </div>
                        </div>
                    </wicket:enclosure>

                    <div class="control-group" wicket:id="minimaalTweeWaardesContainer">
                        <div>Vul minimaal twee velden in en bevestig met de Enter-toets.</div>
                    </div>

                </div>
                <div class="span6">
                    <wicket:enclosure child="labformulierStatussen">
                        <div class="control-group">
                            <label class="control-label">Status formulier</label>

                            <div class="controls">
                                <select wicket:id="labformulierStatussen"/>
                            </div>
                        </div>
                    </wicket:enclosure>
                    <wicket:enclosure child="digitaal">
                        <div class="control-group">
                            <label class="control-label">Digitaal</label>

                            <div class="controls">
                                <div class="btn-group">
                                    <a href="javascript:void(0);" wicket:id="digitaal" class="btn">
                                        <wicket:container wicket:id="label"></wicket:container>
                                    </a>
                                </div>
                            </div>
                        </div>
                    </wicket:enclosure>
                    <wicket:enclosure child="scanDatumVanaf">
                        <div class="control-group">
                            <label class="control-label">Scandatum vanaf</label>

                            <div class="controls">
                                <div class="input-append">
                                    <input type="text" class="datum" wicket:id="scanDatumVanaf"/>
                                    <a href="javascript:void(0);" class="btn" onclick="$(this).prev().datepicker('show');"><i
                                            class="icon-calendar"></i></a>
                                </div>
                                t/m
                                <div class="input-append">
                                    <input type="text" class="datum" wicket:id="scanDatumTotEnMet"/>
                                    <a href="javascript:void(0);" class="btn" onclick="$(this).prev().datepicker('show');"><i
                                            class="icon-calendar"></i></a>
                                </div>
                            </div>
                        </div>
                    </wicket:enclosure>
                </div>
            </div>
        </form>
    </fieldset>
</wicket:panel>
</html>
